Wrist fusion involves the removal of cartilage in certain bones (in red), the adding of bone graft to the gaps, and the reinforcement with a plate and screws.

Severe arthritis of the wrist joint

Two views of a wrist fusion with a plate and screws

What is it?
Wrist fusion (arthrodesis) is performed when there is severe destruction of the wrist joint secondary to arthritis. The operation is intended to stop movement of the wrist but will not prevent rotation of the forearm. The operation involves the removal of cartilage from the bones of the wrist so as to allow these bones to heal together as one. This will be aided by packing bone graft around the joints. This can be taken from the wrist area or from the top of the hip bone. The bones are then held in place by a titanium plate and screws.

Post-operative care
The operation is performed under general anaesthetic. Your hand will be placed in a bulky dressing, which includes a plaster to protect the operation. Movement of the hand and thumb-tip should be continued and you should perform normal light activities after the operation. Hand elevation is important to prevent swelling and stiffness of the fingers. You will stay in hospital for at least one night after your operation. Taking bone from the hip region will not harm the bone or nearby joints but the area can be quite sore for a few days.

Two weeks after the operation your plaster will be changed to a lighter splint. There obviously will be some swelling and bruising. You will need to keep the wrist protected within the splint until the X-Rays show that the bones are joining together (uniting). Unprotected heavy use will ruin the surgery. However, it is permissible to remove the splint in quiet situations and for skin care/washing.

An X-Ray will be taken at 6 weeks after the operation to assess progress. Thereafter you will be able to step up your activities as guided by common sense, using the splint in circumstances where you anticipate the wrist being knocked or strained. The bones will not have joined solidly until around 12 weeks after the operation.

Scar
You will have a scar on the back of the wrist. It will be somewhat firm to touch and tender for 6-8 weeks. Massaging it firmly with the moisturizing cream can help this.

Infection
This can occur after any operation and would be treated by antibiotics.

Nerve damage
Small nerves running in the region can occasionally be damaged during the surgery and either cause numbness on the back of the hand or form a painful spot in the scar (neuroma). The latter complication may require a further operation to correct it.

Delayed or non- union
Union of the bone can sometimes be slower than expected. It cannot be predicted but over-use of the arm can contribute. If the bone fails to unite (non-union), the surgery has to be repeated.

Stiffness
About 5% (1 in 20) of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (CRPS). This problem cannot be predicted but can be contributed to under-use of the arm and failure to do the exercises. It is treated with physiotherapy.

Nerve compression
The swelling in the region can cause pressure on local nerves resulting in pain and pins&needles in the fingers. This may need a releasing operation soon after the fusion operation.